This collection contains theses and dissertations submitted by graduate students under the Department of Biobehavioral Nursing for either a Master of Science degree or a Doctor of Philosophy degree.

Recent Submissions

  • Partnering With a Formal Program: Expanding the Boundaries of Family Caregiving for Frail Older Adults

    Poole, Deborah K.; Department of Biobehavioral Nursing (1999-12)
    Caring for frail older adults at home is an increasingly common lifestyle among American families. A growing array of community-based programs has been developed to assist family caregivers in this endeavor. Certain of these programs are comprehensive in nature and require a particularly close working relationship between the program’s health professionals and the lay caregiver at home. A paucity of literature exists that can act as a guide to formal and informal caregivers within such a context as they strive to develop an effective working relationship. This study used grounded theory methodology to develop a substantive theory of the process by which family caregivers of frail older adults establish and maintain a working relationship with a comprehensive formal caregiving system. The context of the study was a program belonging to the Program of All-inclusive Care for the Elderly (PACE) network. An initial sample of six primary caregivers of PACE participants was selected. The primary means of data collection was in-depth individual interviews with documents review also being used as a data source. An additional 13 primary caregivers were chosen via theoretical sampling for a total sample size of 19 informants. The method of constant analysis was employed to direct data acquisition and analysis until saturation was complete and the core variable was identified. The basic social-psychological problem identified by informants was termed Helplessness, defines by them as “needing additional help with caregiving.” Partnering with the Program was the basic social-psychological process informants used to relieve their helplessness in caregiving. Partnering with the Program was comprised of three phases: Connecting, Discovering Self, and Transcending Self. The first phase of Connecting represented “the honeymoon phase” of the relationship with the program and was made up of three stages: finding out, “joining up”, and adjusting. Discovering Self, the second phase, had three stages: communicating concerns, evaluating the program’s response, and expecting more. Informants in this phase related with the program in a conflicted manner, wanting to assert their autonomy but realizing their dependence on the program. The final phase, Transcending Self, was also made up of three stages. These stages were monitoring, advocating, and choosing to work it out. The hallmark of the final phase was that informants chose to have a positive, family-like personal relationship with the program staff rather than perpetuate conflict over unmet desires about service provision. This substantive theory provided information heretofore unavailable regarding the trajectory of close healthcare relationships from the perspective of the family caregiver. Implications of the theory related to health and social policy, clinical practice with older adults, and nursing knowledge are made explicit in the final chapter of the report.
  • A Grounded Theory Study o f Pain Management Behaviors in Nurses Caring for Preverbal Children

    Noviello, Sheri R.; Department of Biobehavioral Nursing (2006-05)
    A qualitative study using the grounded theory method was used to explore factors that affect nurses’ pain management decision-making when caring for children between the ages o f 0 and 3 years. This study was approved by the Human Assurance Committee at Medical College o f Georgia prior to the collection of data. The sample consisted of eleven nurses who were employed at three different hospitals in the southeastern part of the United States. Theoretical sampling was the basis for the selection o f participants after the first two interviews. Interviews were transcribed verbatim and were subjected to open and axial coding. The constant comparative method was used during data analysis to identify a core category and related concepts. The basic social process that emerged is engaging in tactics o f pain management. This process contained two other processes: assessing fo r pain and managing a pain episode. Intrinsic factors that affected assessing fo r pain included knowing the territory, personal attributes o f the registered nurse (RN), being a parent, and being connected. Extrinsic factors that affected engaging in tactics o f pain management included workload and culture o f the hospital. The process of managing a pain episode included five phases: eliminating other sources o f discomfort, judging pain, comforting, medicating, and letting go.
  • An Interdisciplinary Team Approach to Decision-making About the Use of Psychotropic Medication for Individuals with Mental Retardation

    Natvig, Deborah A.; Department of Biobehavioral Nursing (1993-05)
    The purpose of this study was to examine a decision-making model for developing psychotropic medication plans for individuals w ith mental retardation. The study examined relationships among medication knowledge, acceptance of the interdisciplinary team (IDT) process, leadership, consensus, and the quality of the psychotropic medication plan. The study w as conceptualized using Henderson's Model for Nursing. Henderson (19 6 6 ) identified the nurse as an active participant on the IDT who helps plan and implement care designed to m eet the needs of the individual. T w o hundred eight (N = 208) team members from 4 9 interdisciplinary psychotropic medication review teams participated in th e study. Team s from all four large regional Intermediate Care Facilities for the M entally Retarded (ICFs/MR) in one southeastern state participated. Multiple regression and hierarchical multiple regression analyses were performed to test the hypotheses. The first hypothesis, that consensus would be predicted by medication knowledge, acceptance of the IDT process, and leadership w as partially supported. Leadership w as a significant predictor of consensus. The second hypothesis, that the quality of the psychotropic medication plan would be predicted by medication knowledge, acceptance of the IDT process, and leadership was not supported. The third hypothesis, which added consensus to the model, did not explain any additional variance in the quality of the psychotropic medication plan. As part of this study, The Psychotropic Review for Interdisciplinary Decisions and Evaluation (PRIDE) scale w as developed to assess the quality of psychotropic medication plans. Several threats to statistical conclusion validity were identified, which may have Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. affected the results of the study. These included: small sample size, lack of independence of teams, low variability of responses to instruments, and multicollinearity. Psychotropic medication plans from some ICFs/MR were superior to those produced by others. Characteristics of the ICFs/MR, such as, the amount of guidance given to teams through written guidelines and policy, and the degree of administrative support reflected through availability of staff to participate in the review process, may have been the most significant factors influencing the quality of psychotropic medication plan produced.
  • Evidence for the Escalation of Domestic Violence in 911 Call Records

    McClellan, Ann C.; Department of Biobehavioral Nursing (2002-03)
    This study was a population-based, retrospective, cohort study that examined the trajectory of domestic violence within individual households as reported via emergency 911 calls. A contextual, multi-level, geographically-referenced model was used to explain the relationships among neighborhood level factors, social disorganization indicators; household factors, number of previous episodes and total number of calls; and the escalation of domestic violence, the interval between calls and the level of severity of episodes, within individual households. The neighborhood data were derived from 1990 U.S. census data. Data on the number of domestic violence calls from individual households, the interval between each call, and the level of severity of the episode were derived from the 1997 emergency 911 database of a large southeastern city in the U.S. The pattern of recurrent calls from individual households was examined. Each emergency 911 call in the sample was coded for a set of variables. Associations among neighborhood variables that included economic status, family structure, racial composition, residential mobility, and structural density and the two outcome measures were examined. To estimate the effects of the neighborhood variables, the emergency 911 calls were linked to their respective census tracts using street addresses. Data were analyzed using a hierarchical approach. Evidence was found for the escalation of domestic violence. The number of days between consecutive episodes of violence decreased as the number of episodes of violence within a household increased. The severity of episodes of violence also increased with each subsequent episode of reported violence from the household. The proportion of female-headed householders with children in a neighborhood, a measure of family structure, was related to both the initial call interval and severity of the initial episodes of violence in households. There was significant unexplained variation among households within neighborhoods for both outcome measures. Further, neighborhood social disorganization was related to the rate of domestic violence in neighborhoods. Emergency 911 call data could provide a promising source of data for a domestic violence surveillance system, especially when linked to other data sources such as official police records.
  • Health Disparities in Acute Outcomes of Life-threatening Injury

    NeSmith, Elizabeth Grooms; Department of Nursing (2007-12)
    Health disparities have been documented in nearly all-leading causes of death. It is unknown if health disparities also exist in acute outcomes of life-threatening injury. The overall research question for this dissertation was, “Do health disparities exist in acute outcomes of life-threatening injury?”. Three studies were conducted: a state of science, a validity study, and a descriptive study. The state of the science showed that only 4 of 352 studies reported disparities, while 3 of 352 studies reported no disparities. The validity study was a retrospective chart review and showed that the instrument used to measure systemic inflammatory response syndrome was valid in predicting intensive care unit length of stay (F = 15.83) p < .0001. Caucasian race also predicted intensive care unit length of stay (F = 9.7) p = .002. When combined with race, the systemic inflammatory response syndrome instrument explained more variance (R2 = .15) in intensive care unit length of stay than either variable alone (F = 7.7) p = .006. The descriptive study utilized the same data set from the validity study, and showed fewer occurrences of systemic inflammatory response syndrome in African Americans than in Caucasians (T = 9949.5) p = .04; in adults 30-44 years old than in adults 18-29 (T = 13,654) p = .04; and in ethyl alcohol users than in all other substance users (X2 = 7.85) p = .005. There was less severity of systemic inflammatory response syndrome in females than in males (T = 7,491.5) p = .03; and in marijuana users than in all other substance users (T = 3,117) p = .02. More severity of systemic inflammatory response syndrome was found among ethyl alcohol users than in all other substance users (T = 2,667) p = .0008. Results support that health disparities exist among different patient groups according to race, age, sex, and substance use for systemic inflammatory response syndrome. More research is needed to determine if these disparities translate to increased risk for poor outcomes. Implications for practice include increased vigilance of different patient groups based on occurrence and severity of systemic inflammatory response syndrome.
  • Race and Income Association with Health Service Utilization for Veterans with Heart Failure

    Landrum, Laurie G.; Department of Nursing (2012-07)
    Disproportionate heart failure outcomes exist for Blacks in the Veterans Health Administration (VHA) despite equitable access and financial barrier minmization. No study has examined the association of race and income with health service utilization for veterans with heart failure. This observational study investigated race and income associations with readmissions, bed days of care, and emergency room (ER) visits for veterans with heart failure after controlling for predisposing, enabling, and illness severity factors. Medical record data were collected for 149 veterans telemonitored for heart failure during 2008-2011. Heart failure symptoms severity and comorbidities were measured using investigator-adapted scales based on the New York Heart Association IIV scale and the Charlson comorbidity index. Heart failure related outcomes (30 day, 90 day, 1 year, and total readmissions, ER visits, and total bed days of care) were modeled controlling for age, marital status, and heart failure and comorbidity severity. Of patients younger than 60 years of age, 18% were Black compared to 11% of Whites, Χ2 (2, N=149) = 5.15, p= .02. Blacks had a much higher comorbidity prevalence than Whites, p = .000. Ischemic heart disease and chronic kidney disease rates were double and triple national VHA rates, respectively, among Whites and Blacks. Race did not predict readmissions, bed days of care, or ER visits. The odds of a readmission or bed day of care ever decreased by 38% and 43%, respectively, for married men, p = .03. The odds of a readmission or bed day of care ever due to severe heart failure—compared to less severe heart failure—were four to five times higher, respectively, p ≤ .004. Income increased the odds of total bed days of care by 14%, p = .00, holding race constant. Overall, the sample experienced far fewer readmissions, bed days of care, or ER visits, compared to VHA national rates, but sample size may have limited accurate comparisons.
  • An Analysis of Diabetes Predictors and Diagnostic Tests in a Sample of African Americans at Risk for Diabetes

    Williams, Lovoria B.; Department of Biobehavioral Nursing (2011-05)
    Recently the ADA and International Expert Committee (IEC) endorsed HbA1C for diagnosis of glucose states. Concerns exists regarding discordance between fasting plasma glucose (FPG) and HbA1C; the committees do not agree on the HbA1C cut-point for diagnosis of sub-diabetic states; and the HbA1C may be more sensitive in AAs. A secondary data analysis of the Fit Body and Soul (FBAS) sample (n = 393) was conducted. FPG and HbA1C values were classified by the current ADA and the IEC HbA1C criteria. A risk factor analysis was also conducted. Results indicate different subject classification based on choice of diagnostic test and criterion used. Subjects classified as normoglycemic based on ADA FPG, ADA HbA1C and IEC HbA1C criterion were (78.9%; 30.7%; 55%) of the sample, respectively. Sub-diabetic state was (18.1%; 55.9%; 31.5%), respectively. Diabetes was (3%; 13.4%; 13.4%), respectively. Moderate correlation exists between HbA1C and FPG (Pearson’s r = 0.63 p < 0.001); there is only slight to fair agreement between ADA HbA1C and ADA FPG classifications and IEC HbA1C and ADA FPG classifications; Cohen’s Kappa = 0.127; 0.234 (p < 0.001), respectively; McNemar’s Chi Square (χ23df = 182.8; 81.54 p < 0.001) respectively. Significant predictors of HbA1C by linear regression were waist circumference (WC) and age; FPG predictors were age, WC and family history of diabetes. The risk factor analysis indicated poor agreement with either diagnostic test.
  • A Mindfulness Model of Emotion Regulation in Nursing Students: Working Memory Capacity as a Regulatory Mechanism

    Dubert, Christy J.; Department of Nursing (2013-04)
    Nursing students often struggle with transitioning from education into clinical practice. These students may be overwhelmed with the emotional demands and high cognitive load resulting from the unpredictable post-graduation/professional work environment. A lack of research exists investigating how nursing students regulate their emotions and what cognitive emotional regulation strategies they use when dealing with the cognitive and emotional demands of nursing school. The integration of mindfulness training into nursing curricula has the potential to facilitate the development of nursing students’ working memory capacity (WMC) and improve emotion regulation (ER) skills. Although a few studies have investigated mindfulness training with nursing students, there is a lack of empirical evidence examining how dispositional mindfulness and WMC influence a nursing student’s ability to regulate their emotions. Research evidence suggests that dispositional mindfulness is linked to ER. However, whether: (a) ER is influenced by dispositional mindfulness; (b) WMC mediates this relationship; and (c) if these factors are different between education levels has not yet been determined in nursing students. This cross-sectional study examined the relationships between mindfulness, WMC, and ER in a pre-licensure nursing student population from a southeastern Georgia university. Two questionnaires and a WMC task were completed by the sample (n = 80). A path model of the relationships between mindfulness, WMC and ER was tested using structural equation modeling. Factor differences between the four education levels were tested using one-way ANOVA. Mindfulness was positively associated with ER (r = 0.1905, p = 0.045) and WMC (r = 0.2977; p = 0.004). The path analyses revealed that there was a direct effect of mindfulness on ER (γ11 = 0.292, p = 0.034) and WMC (γ21 = 4.975, p = 0.004). However, the indirect effect of mindfulness on ER was not statistically significantly mediated by WMC (β = - 0.03, p = 0.236). Furthermore, mindfulness was significantly different between the first semester students having the highest level of mindfulness and the fourth semester students having the lowest level of mindfulness, F(3, 76) = 4.12, p < 0.05. Dispositional mindfulness may influence ER and WMC in nursing students, but the downward trend of mindfulness from first to last semester is concerning. Nurse educators may consider using mindfulness training to enhance mindfulness, WMC and ER.
  • Understanding African American women church members' health decision-making and described behavior: a qualitative inqui

    McCall, Amber Brown; Department of Biobehavioral Nursing (2011-12)
    This dissertation described the processes that African-American women church members used to make health decisions and investigated the experiences and perceptions that faith had on this cohort‘s health beliefs. African-American women historically have suffered disproportionately from health disparities, and African-American women church members have played a central role as their families‘ primary caregiver. It is perceived that faith-based interventions can be effective at reducing health disparities. However, there is little understanding of the impact on the health decision-making process. By undertaking an investigation into this process in a cohort of African-American women church members, this study incorporated and advanced nursing theories used to guide the development of risk-reduction interventions through describing and delineating the role of faith-based health decision-making. A purposive, intensity sample of eleven African-American women church members were recruited to participate. Naturalistic inquiry methodology was used to analyze the interview data, answering the following questions: 1) What process(es) do African-American women church members use to make health decisions, and what health behaviors do these women describe? 2) What is the role of faith (if any) in the health beliefs of African-American women church members? The results indicated religious faith was integrated throughout the health decision-making process; additionally, three overarching processes were used by the study subjects, which are described herein as: 1) Believing in God, 2) Empowering Self, and 3) Using Resources. This demonstrated that their faith was a major influence in the lives participants and that faith impacted their competence and ability to be empowered and resourceful—as well as influenced health decision-making. Due to the targeted, purposive sampling methods along with the qualitative nature of the data obtained from study participant interviews, these research results cannot be generalized to the general population of African-American women. Nevertheless, understanding the process of health decision-making in this sample may be important to enabling researchers, clinicians and clergy to promote further research regarding the interplay of faith in health decision-making, risk reduction activities, and quality of life. The implications for nursing theory, practice and research, and empowering the community are included, and provide the essential foundation for this study.
  • Adoption of AACN Verification of Feeding Tube Placement Practice Alert by Critical Care Nurses

    Bourgault, Annette M.; Department of Nursing; Georgia Regents University (2012-04)
    The intent of clinical practice guidelines is to help bridge gaps between evidence and practice, yet there is no correlation between availability of guidelines and changes in practice. Little is known about how critical care nurses adopt guidelines, since few studies have sampled nurses exclusively. This descriptive, exploratory study examined factors influencing adoption of the American Association of Critical-Care Nurses (AACN) Verification of Feeding Tube Placement Practice Alert and four clinical practices recommended by this guideline.